Abstract
In this study the perceptions and experiences of Registered Nurses (RNs) nursing adolescents in an adult mental health (MH) unit were explored with the aim of identifying any nursing concerns regarding such admissions. The reasons adolescents access adult MH in-patient services were also sought alongside what training and knowledge RNs had in relation to the assessment and management of adolescents with MH problems. Findings led to identification of areas of the nursing care environment that may be improved or developed to enhance quality of care.
A qualitative study using a general inductive approach was undertaken to investigate the world of the participants, rather than having a basis solely in the literature (Field & Morse, 1985). A purposive sample using a criterion strategy was used to recruit participants who were considered representative across the clinical nursing staff (Patton, 2002). Semi-structured interviews using an interview guide were audio recorded, then transcribed as verbatim responses. Nine categories were formed from the raw data, each category was then systematically analysed to find patterns of commonality and difference, from which three major themes emerged. Categories were emotional response; personal beliefs; memorable experiences; role; environment; concerns and changes; physical development; cognitive development; social / emotional development. Emergent themes were Attitudes and experiences; Practice implications; and Knowledge.
What is drawn from this study is that RNs made positive or negative evaluative judgements of adolescents based on their knowledge and expectations of them which were influenced by their experiences, beliefs, and emotional response. Differences in RNs’ understanding, and tolerance of adolescents was found to affect reciprocal interactions and responses. Negative memorable experiences and negative emotional response correlated with negative attitudes about adolescents and reluctance to work with them. Negative experiences were linked to the RN’s lack of understanding, feeling dis-empowered, and with incidents that clashed with personally held beliefs. Admission to the adult unit was primarily to provide a safe environment in which to effectively manage the increased risks associated with the adolescent’s presentation; most commonly self-harm and suicidality. The other major reason was the lack of alternative options outside normal office hours, and beds were not always available when required. RNs lacked education and knowledge relevant to adolescents with mental illness, were not adequately prepared to work effectively with this client group, and the adult MH unit was not adequately resourced to meet the needs of adolescents.